Care Home: Hawksbury House

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What the care home does well The staff collects information together about the person before anyone moves into the home to make sure they can meet their needs. The staff have formed good relationships with the residents and make sure their rights to privacy and dignity are met. They work hard to promote residents independence at all times. Visitors are made welcome and there are good links with the local community. Residents and relatives said they would be able to use the complaints procedure if they had a concern.Staff work hard to provide activities inside and outside of the home. The meals are nutritious, nicely presented and choices are available. The staff receive the training they need to care for the residents needs. A number of staff have worked together at the home for a long time. They said they get plenty of support from the senior staff and enjoy working at the home. Residents personal moneys are looked after safely. The home is a clean, pleasant and comfortable place to live. Residents have brought some small items with them making their own bedrooms individualised and homely. What has improved since the last inspection? The Statement of Purpose and Service User Guide have been updated to make sure residents and their representatives have clear information about the care and services provided in the home. Care plans are now clear about the care provided. Residents and their representatives are being involved in how their care is planned to make sure their wishes are respected. Information about residents` previous lifestyles and choices are being written down so that staff can continue to support them. All medication is now being given safely. The lounge that was damaged by fire earlier in the year has been totally refurbished. Planning permission has been received to change this room into an en-suite bedroom. Staff files have two references. Fire training has taken place for all staff What the care home could do better: All events, which affect the well-being or safety of any residents, needs to be reported to the Commission for Social Care Inspection. The registered manager should consider increasing the number of adapted bathrooms in the home. CARE HOMES FOR OLDER PEOPLE Hawksbury House Kellfield Avenue Low Fell Gateshead Tyne & Wear NE9 5YP Lead Inspector Irene Bowater Unannounced Inspection 27th November 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hawksbury House Address Kellfield Avenue Low Fell Gateshead Tyne & Wear NE9 5YP 0191 482 1258 0191 482 5158 hawksburyhouse@aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr John Henry Beckett Mrs Jacqueline Murray, Mrs Freda Agnes Beckett Mrs Jacqueline Murray Care Home 35 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (25) of places Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 25 2. Dementia - Code DE, maximum number of places: 10 The maximum number of service users who can be accommodated is: 35 20th June 2007 Date of last inspection Brief Description of the Service: Hawksbury House is a large, adapted two-storey house with an extension. It is situated in a quiet residential area of Low Fell close to all local amenities and a short drive from Gateshead, Newcastle and the Metro Centre. The building comprises of three double bedrooms and twenty-nine single bedrooms, many with en-suite toilet facilities. All rooms are suitably furnished and have an emergency call system. A passenger lift is available to service the two floors. The Home has wide doors and corridors to allow easy access for wheelchair users, with the exception of a short area of corridor leading to the main ground floor lounge, which is slightly narrower, but still allows access. The home has two lounges, a lounge/dining room, a separate dining room, and a hairdressing room. There are well-maintained gardens to the front and rear of the home and adequate car parking facilities. Staff provide personal care for up to 35 older people, some of who have specific and complex needs. Nursing care is not provided. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 5 The statements of purpose and service user guide are up to date and readily available in the home. There are extra charges for newspapers, hairdressing, chiropody, optician and dental care. The fee rates vary from £394:00 to £420:00 Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Before the visit: We looked at: • Information we have received since the last visit on 20 June 2007 • How the service dealt with any complaints and concerns since the last visit • Any changes to how the home is run • The provider’s view of how well they care for people • The views of people who use the service and their relatives, staff and other professionals The Visit: An unannounced visit was made on date 27 November 2007 During the visit we: • Talked with people who use the service, relatives, staff and the manager. • Looked at information about the people who use the service and how well their needs are met • Looked at other records which must be kept • Checked that staff had the knowledge, skills and training to meet the needs of the people they care for • Looked around the building the building to make sure it was clean, safe and comfortable • Checked what improvements had been made since the last visit. We told the manager what we found. What the service does well: The staff collects information together about the person before anyone moves into the home to make sure they can meet their needs. The staff have formed good relationships with the residents and make sure their rights to privacy and dignity are met. They work hard to promote residents independence at all times. Visitors are made welcome and there are good links with the local community. Residents and relatives said they would be able to use the complaints procedure if they had a concern. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 7 Staff work hard to provide activities inside and outside of the home. The meals are nutritious, nicely presented and choices are available. The staff receive the training they need to care for the residents needs. A number of staff have worked together at the home for a long time. They said they get plenty of support from the senior staff and enjoy working at the home. Residents personal moneys are looked after safely. The home is a clean, pleasant and comfortable place to live. Residents have brought some small items with them making their own bedrooms individualised and homely. What has improved since the last inspection? The Statement of Purpose and Service User Guide have been updated to make sure residents and their representatives have clear information about the care and services provided in the home. Care plans are now clear about the care provided. Residents and their representatives are being involved in how their care is planned to make sure their wishes are respected. Information about residents’ previous lifestyles and choices are being written down so that staff can continue to support them. All medication is now being given safely. The lounge that was damaged by fire earlier in the year has been totally refurbished. Planning permission has been received to change this room into an en-suite bedroom. Staff files have two references. Fire training has taken place for all staff Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Standard 6 does not apply to this service. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Good information is available to help prospective residents make an informed choice about where to live. The admissions process fully ensures that residents’ needs are assessed prior to care being offered. EVIDENCE: The Statement of Purpose and Service User Guide have been changed since the last visit to the home. The “Welcome to Hawksbury House” style brochure gives easy to understand information with lots of photographs, which helps people to understand what services are provided. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 11 There is also a DVD, which the residents have helped put together. Case tracking of three residents showed that both the registered manager and care managers complete assessments in order to ensure that residents needs can be met in the home. Admission information is detailed and gives information about previous lifestyles, including background, cultural, religious or other needs and how this will help residents to settle into the home. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Care planning systems provide good information for staff to consistently meet residents changing needs. Health and personal care is well met so that the care people receive is based on their individual needs. Robust systems for the administration of medicines are in place. This makes sure that residents receive their medication safely. A good level of personal support is in place, which promotes peoples rights to privacy and dignity. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 13 EVIDENCE: Since that last visit to the home the staff have worked very hard to bring care plans up to date. Each resident has a care plan that has been developed with the help of information gathered before they came to live in the home. Risk assessments are in place for falls, moving and handling, nutrition and pressure sore care. Information is also gathered about residents social and religious care needs so that the staff can help them maintain their lifestyles whilst living in the home. Care plans showed that they are now fully completed, dated and signed. They have been reviewed and any changes recorded. This means accurate information about how residents care needs are met is available and staff can give the right care. Previous life histories are available and the care plans are now starting to reflect a person centred approach to care delivery. Families are included in regular reviews that are held to establish if needs of the resident have changed. Recent care reviews with care managers’ show that residents and their representatives are happy with the service and care provided by the staff. The residents have access to all NHS facilities to ensure their healthcare needs are met. There are regular visits from GP’s including, opticians and chiropody services. Advice and support is available from other healthcare professionals when required such as the District Nursing Services, Continence Advisor, Tissue Viability Nurse, Occupational Therapist and Speech and Language Therapists. The home uses a monitored dosage system for administration of medicines that are prescribed to residents. This system is designed to minimise the risk of any errors when used correctly. Medicines are put into individual blister packs by the pharmacy and sent to the home every month. Some medicines cannot be safely stored in the blister packs and they are dispensed in bottles or packets. The senior care staff and manager administer medication to residents and staff have completed a “Safe Handling of Medicines” course. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 14 Records are in place for all medicines received, administered and disposed of. The Medicine Administration Records (M.A.R.) showed no discrepancies. Since the last visit a new Controlled Drug book has been provided. This is a hard backed bound book with numbered pages. All entries were clear written with two signatures. Weekly audits are now carried out to make sure no errors are occurring. Care was given in a discreet, respectful manner, with staff knowledgeable about residents’ preferences. Examples include having a key to their room, receiving their mail unopened, being addressed by their preferred name and being able to go wherever they wish inside and where possible, outside of the home. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. A good range of social activities is provided which provide stimulation and interest for residents living in the home. Good support from relatives and representatives makes sure residents have opportunities to maintain their previous lifestyles. Residents are well supported to make choices and take control over their lives. Good choices of nutritious and appetising meals are available to ensure individual dietary needs and preferences are met. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 16 EVIDENCE: There is an activities organiser in the home and she organises activities and events both inside and outside of the home. Talking to residents confirmed that they are able to take part in activities if they wish to do so. On the day of the site visit several of the residents were going out on a shopping trip to Dobbies Garden Centre. The notice board displays past and future events including visits to Saltwell Park and the Baltic Centre. Events planned for the Christmas season include visits by the local school choirs, church and carol services, Christmas Party lunch at the Swallow Hotel, a Christmas party at the home and a visit to the Pantomime. Weekly activities include board games cookery, newspaper reviews and card making. The staff supports anyone who wishes to go out locally to do shopping. Information about advocacy is readily available but all of the residents said that the manager would “always sort anything out”. All of the residents have brought small items with them making their own bedrooms homely and personalised. There are no restrictions on visiting times and residents confirmed that their visitors are made welcome at anytime. The tables were nicely set with tablecloths, condiments, napkins and suitable cutlery. Residents said they were always asked what they wanted and could always choose something else if they didn’t like what was offered. The meal reflected the menu plan, and the choices of meal were written on a whiteboard in the dining area so that residents were aware of what they could have. Lunchtime was an unhurried pleasant time. Staff were asking residents if they needed any help and offering them more to eat and drink. The tables were nicely set with tablecloths, condiments, napkins and suitable cutlery. Residents said they were always asked what they wanted and could always choose something else if they didn’t like what was offered. The meal reflected the menu plan, and the choices of meal were written on a whiteboard so that residents were aware of what they could have. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 17 The lunchtime meal consisted of beef stew and dumplings, creamed potatoes, carrots and green beans. Rice pudding with jam was served for dessert. Comments about the food included: “The food is lovely” “There is always plenty” Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The complaints procedures are clear. Residents and relatives are confident that their views are listened to and acted upon. Arrangements for the Protection of Vulnerable Adults are satisfactory and protect residents from harm. EVIDENCE: The home has clear complaints policies and procedures, which are displayed, in the home. The records showed that complaints are documented appropriately and include outcomes with signatures obtained to confirm the complainant’s satisfaction of the outcome. There have been two complaints received this year and they have been resolved at home level. All of the residents spoken with said they had nothing to complain about but were very clear that the manager would deal with any issue immediately. Within the complaints documents are many compliment letters and cards from relatives to the Manager and staff for the care and support given to residents and relatives, both during their stay in the Home and after death. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 19 The Home has a Protection of Vulnerable Adults Procedure (POVA) in place and a copy of the Local Authority’s Procedural Framework for the Protection of Vulnerable Adults, is available to staff. The staff complete training with an external training agency. Training with the local authority is to be sourced for the staff. There has been one Safeguarding Alert initiated by the Home and reported to both the Local Authority and the Commission for Social Care Inspection.This has been appropriately dealt with. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home is clean, warm, well maintained and suitably decorated so that the residents have a homely and safe environment to live in. EVIDENCE: This is a large, adapted two-storey house with an extension.Ther are two lounges, a lounge/dining room, a separate dining room, and a hairdressing room. There are well-maintained gardens to the front and rear of the home and adequate car parking facilities. There is an ongoing redecoration programme and the furnishings and fitting are of a good standard. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 21 The lounge that was damaged by fire at the beginning of the year has now been totally refurbished. Planning consent has been sought and obtained to change this lounge into an en-suite bedroom. This work is near completion. A bedroom at the front of the building is to be changed into a lounge. This means that the number of registered beds remains unchanged. Bedrooms have en suite facilities. Only one bathroom on the ground floor is used for all the residents as this has an adapted bath. The other bathing facilities including the shower are not used. All of the bedrooms inspected were clean, decorated and furnished to a good standard. Many of the residents have brought small items of furniture and keepsakes with them making the rooms highly individualised. Bedrooms are only shared in limited situations and only with agreement with the people using the service. They are always given the choice to move to a singe room when one becomes available. The home is well lit, clean and tidy and fresh smelling. Staff were observed to follow infection control procedures. The laundry is small but clean and organised. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The current staffing levels are sufficient to meet the residents’ needs. Training for staff makes sure they have the competence to care for all of the residents needs. The residents are kept safe and supported by good recruitment procedures that prevent unsuitable people from working in the home. EVIDENCE: The rota reflects the staff on duty over the twenty-four hour period. The day shift starts at 07:30 am until 13:45 or 16:00 and the late shift starts at 14:00 or 16:00 until 10:15 pm. The night shift starts at 10:15 until 08:30 am. There is an overlap of staff during the twenty-four hour period to make sure residents needs are being met. The home benefits from a stable staff team who have worked at the home for some time. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 23 The registered manager is supernumerary. The home has a deputy manager and senior care staff. Ancillary staff includes cook, kitchen assistant, laundry, domestic, maintenance and administration. Residents said: “They are wonderful staff” “The staff are really very good”. Three staff files showed that recruitment procedures are followed. Job descriptions and roles are clear and each file had an application form completed. There was evidence of Criminal Record Bureau checks, Protection of Vulnerable Adult checks, and proof of identity. Staff complete an induction programme and have a training and development file. Records show that staff have completed training in food hygiene, infection control, moving and assisting, fire prevention and safe handling of medicines. Other training includes positive dementia care and malnutrition. Over 77 of staff have completed National Vocational Qualifications (N.V.Q.) to level 2 and four staff are completing NVQ level 3. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home has an experienced manager who provides leadership and guidance. This makes sure the home is run in the best interests of people using the service. Good systems for consultation and quality monitoring make sure that the views of residents are sought and acted upon. Residents personal accounts are well managed to make sure their best interests are protected. The health, safety and welfare of residents are being protected as far as reasonably possible. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 25 EVIDENCE: The registered manager has a Registered Nurse qualification, Registered Managers Award and NVQ level 4.She has many years experience in caring for older people. She attends training to update her knowledge and skills whilst managing the home. The responses from the comment cards and from discussions on the day confirmed that she is approachable, available and supportive at all times. A quality assurance survey has been completed which shows that residents are more that satisfied with the service provided. Comments from this included the flowing: “It’s home from home “Love it here” “Happy with everything” “Staff are patient and kind”. Regular staff and residents meeting are held. The minutes are recorded and displayed on the notice board. Concerns have an action plan showing how things are going to be put right. An audit of three residents personal allowances was carried out. There were no discrepancies. All had individual records and separate wallets containing their money. The records are dated with two signatures and receipts are available for all transactions. Evidence was seen in the records and staff confirmed they had received training in health and safety issues such as, food hygiene, first aid, infection control, moving and handling and COSHH (Control of Substances Hazardous to Health). Accidents are recorded and the manager carries out an analysis to examine any trends. The home does not always inform the Commission when residents have to attend hospital after an accident, which results in injury. Staff now have completed received fire training at the required intervals of three monthly for night staff and six monthly for day staff. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 26 There is a fire risk assessment and a fire inspection was carried out January 2007 following the fire in the upstairs lounge. External contracts were available and up to date. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 37 Requirement The registered person must ensure that the Commission for Social Care Inspection is always informed of any event that affects the well being or safety of the residents. This includes attendance at hospital after an accident. Timescale for action 31/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP21 Good Practice Recommendations The registered manager should review and improve the assisted bathing facilities in the home. Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hawksbury House DS0000007379.V355171.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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